Presently, predicting cup size after reduction mammaplasty is largely based on experience. Regnault and Daniel (1984) proposed a formula for estimating the appropriate weight of reduction to achieve a desired cup size. To validate their method, we studied 75 consecutive patients undergoing bilateral breast reduction mammaplasty. Patients were measured pre-operatively and 6 weeks post-operatively using two techniques to determine bra size. Actual weight of breast tissue excised was compared to the predicted values using the Regnault and Daniel formula for each measuring technique (Methods A and B). A modified formula (Method C) was developed to increase the accuracy. The results obtained using Methods A and B were compared with those of Method C. A paired sample t test showed no significant difference between actual and predicted weight of reduction for using Method A or C. Method B systematically underestimated the weight of tissue to be removed. The mean estimate for Method B was 730 g, a difference of -45 g (CI: -81.7 to -8.9; p = 0.015). For Method A, the mean was 765.5 g, a difference of 9.4 g (CI: -68.1 to 49.3; p = 0.75). This compared to Method C where the mean predicted weight of tissue to be removed was 770.4 g, a difference of -4.5 g (95% CI: -42.4 to 33.4; p = 0.81). The implications of these findings are discussed.
Bipedicle flaps have been used to provide good quality soft tissue cover for defects in many anatomical sites. The indications for the use of this flap have not been well defined and with the advent of more complex modes of tissue transfer this simple technique is often overlooked. We have found it to be a safe and expedient method of providing cover for difficult defects on the extremities. We present a series of 9 flaps raised on 7 patients over a 12-month period and discuss the indications and refinements in flap design.
We describe a three staged method of reconstruction for partial helical rim defects using a thin post auricular tube pedicle. The technique is illustrated by three case reports.
